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. 2016 Oct 18;5(1):1807.
doi: 10.1186/s40064-016-3495-4. eCollection 2016.

Continuous intra-arterial nimodipine infusion in refractory symptomatic vasospasm after subarachnoid hemorrhage

Raimund Helbok  1 , Alexandra Zangerle  1 , Andreas Chemelli  2 , Ronny Beer  1 , Thomas Benke  1 , Rainer Ehling  1 , Marlene Fischer  1 , Martin Sojer  1 , Bettina Pfausler  1 , Claudius Thome  3 , Erich Schmutzhard  1
Affiliations

Continuous intra-arterial nimodipine infusion in refractory symptomatic vasospasm after subarachnoid hemorrhage

Raimund Helbok et al. Springerplus. .

Abstract

Introduction: Vasospasm still is a major cause of morbidity after aneurysmal subarachnoid hemorrhage. The purpose of this report is to describe the successful management of severe refractory vasospasm with continuous intra-arterial nimodipine (IAN) treatment.

Case description: A 72-year old right handed woman was admitted with non-traumatic SAH WFNS grade 1. Cerebral computed tomography demonstrated thick blood filling of the basal cisterns, and intraventricular hemorrhage. Cerebral angiogram failed to detect a vascular abnormality. After an uneventful initial course the patient developed symptomatic left middle cerebral artery vasospasm with aphasia and corresponding restriction in diffusion weighted images in the left frontal lobe. Bolus IAN only transiently improved cerebral circulation and clinical signs and symptoms. Continuous-IAN was started and led to full clinical recovery and normalisation of MRI diffusion restrictions.

Discussion and conclusions: Continuous selective intra-arterial infusion of nimodipine may be an option in selected patients with symptomatic vasospasm refractory to conventional treatment after careful consideration of benefits and procedure-related risks.

Keywords: Delayed cerebral ischemia; Nimodipine; Subarachnoid hemorrhage; Vasospasm.

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Figures

Fig. 1
Fig. 1
Axial head computed tomography showing subarachnoid hemorrhage with thick blood filling the basal cisterns
Fig. 2
Fig. 2
Axial magnetic resonance imaging demonstrating severe left middle cerebral artery vasospasm (time of flight angiography, white arrow) and left frontal cortical hyperintensities (diffusion-weighted imaging) before (a), 3 days after (b) continuous intra-arterial nimodipine treatment and at 23d follow up (c)
See this image and copyright information in PMC

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